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OPTIMIZATION OF THE TREATMENT AND DIAGNOSTIC
ALGORITM FOR PERFORATED PYLORODUODENAL ULCERS.
Khojimetov D.Sh.
Sayfuddinov S.Z.
Andijan State Medical Institute.
https://doi.org/10.5281/zenodo.15362813
Relevance.
Duodenal ulcer perforation is still a common complication of
chronic peptic ulcer disease. Despite the wide spread use of anti‑secretory and
H. pylori
eradication therapy, the incidence of perforated duodenal ulcer (PDU)
has changed little. Most of the literature pertaining to the situation in the
developed world, showed that the disease is largely confined to the elderly
patients taking ulcerogenic medications. The situation in the developed nations
is summed up by Johnson: “The surgeon’s major role in the management of
peptic ulcer disease will be the performance of life‑saving emergency operations
in the elderly unfit patient.” In contrast to the developing world, the patients are
younger and have a long life‑time of potentially useful activity ahead of them as
anti‑secretory and anti‑
H. pylori
eradication drugs are been freely used, we had
expected an improvement in this disease condition. Hence, we set out in this
review to look at the prevalence, pattern of presentation, risk factors and
management outcome in the study environment and we also set out to look at
the management pattern if sufficient for a semi‑urban area in a developing
world.
The frequency of complications of peptic ulcer perforation varies
according to various authors from 3 to 30%, averaging 10-15%. The mortality
rate is 5 - 17.9%.
Material and methods.
During 2016-2024, 147 patients with ulcer
perforation were admitted to the Department of Surgery of Andijan State
Medical Institute, of which 5 (3.41%) underwent suturing of perforated
duodenal ulcer, 13 (8.84%) underwent gastric resection (GR) and 129 (87.75%)
underwent excision of PDU. In all patients, along with the study of clinical and
anamnestic data, modern methods of instrumental diagnostics were used.
Purpose of the study.
To improve the results of diagnostics and the choice
of surgical treatment method for perfractured duodenal ulcers (PDU).
Treatment algorithm.
According to the developed treatment and
diagnostic algorithm, with the period from the moment of perforation to 12
hours, the diameter of the perforated ulcer up to 2 cm, by prevalence of local and
diffuse peritonitis, by the nature of the effusion - serous and serous-fibrinous, at
any age of the patient and with chronic duodenal ulcer, an indication for excision
of the perforated ulcer was made. With the intact pyloric sphincter, the method
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of choice was excision of the PDU while maintaining the integrity of the SP with
duodenoplasty. If a "mirror" pyloroduodenal ulcer was detected, submucous
excision of the ulcer edges on the posterior wall was mandatory, single-row
interrupted sutures were applied with silk thread, thereby the ulcer bottom
remained outside the intestinal tube, i.e. extraduodenization of the ulcer bottom
was performed. Also, at the age of up to 50 years, with a relatively satisfactory
condition of the patient, in all patients with ulcer perforation in combination
with stenosis, an economical gastric resection was performed with direct
imposition of a gastroduodenal anastomosis.
If the period from the moment of perforation to admission to the hospital
was more than 24 hours, with any size of ulcers, general peritonitis and purulent
nature of the effusion contents, regardless of the patient's age, absence or short
medical history and presence of severe concomitant diseases, the perforation
opening of the ulcer was sutured.
Conclusion.
Thus, adhering to the proposed algorithm, we optimized the
choice of the surgical method (ulcer excision, RG, suturing). Also, the proposed
algorithm led to a sharp decrease in immediate postoperative complications and
the absence of mortality.
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